Overactive Bladder

In a healthy bladder, the muscles of the bladder walls gradually expand to make room for more urine as the bladder fills up. At the same time, the muscles that surround the urethra (the tube you urinate from) tighten to hold in urine. Once the bladder is full, the brain sends signals to the urethra and pelvic floor muscles to relax, and to the bladder muscles to squeeze, pushing urine out of the body.

In women with overactive bladder (OAB), the bladder wall muscles will suddenly and inexplicably contract, creating a strong urge to urinate, even when the bladder isn’t full. In addition, the muscles of the urethra and pelvic floor relax as they typically would, to allow the passage of urine. The result can be sudden involuntary loss of urine (urge incontinence)—either a dribble or, in some cases, the entire contents of the bladder. It can also result in a feeling of needing to rush to the bathroom to urinate frequently or a powerful urge to urinate that is difficult to put off, even when you have just urinated.

While it’s uncertain what exactly causes the muscles of the bladder wall to begin contracting, certain underlying health conditions or dietary triggers can make these muscle spasms more likely. In addition, environmental cues for bladder wall spasms include the sound of running water, putting your key in the door at home or seeing the toilet.
Behavior:
  • Don’t delay a trip to the bathroom once your bladder is full. Make sure you have a place to go and can excuse yourself in social situations.
  • Once in the bathroom, make sure to empty your bladder completely. Instead of straining muscles, stand up or shift position, then sit down and urinate again.
  • To deal with urine leakage, use only all-cotton or incontinence pads (not menstrual pads). All-cotton pads are gentler on the skin and are more breathable. This helps prevent skin irritation and infection. Let the skin air out and dry when possible.

Diet:
  • Certain types of drinks can provoke bladder spasms. The most common culprits are coffee, tea, sodas and other beverages with caffeine. Artificial sweeteners, fruit juices and alcohol can also bother your bladder.
  • Keeping a diary of what you drink and how you feel afterward can help you look for a connection between your diet and bladder symptoms. It is helpful to bring this diary to your appointment for your health care provider to review, and can be beneficial in diagnosing why you are leaking urine or having urinary urgency or frequency.
  • Drink the right amount of water—about 60-80 ounces per day. Drinking too much water will make you need to use the bathroom more often. Drinking too little water will make your urine concentrated and irritate your bladder.
  • Eat plenty of fiber to keep your bowels working normally, as constipation can increase OAB.

Exercise:
  • Yoga: Research indicates that yoga can be an effective treatment for OAB and urge incontinence, especially poses and breathwork designed to strengthen and bring awareness to the pelvic floor region.
  • Kegel exercises: Kegels are one type of exercise designed to prevent, reduce or eliminate incontinence. You can strengthen the muscles of the pelvic floor with a simple squeeze-and-release movement. If you find this difficult or you aren’t sure if you are doing this correctly, there is pelvic floor physical therapy that can help you.

Lifestyle Factors:
  • If you’re overweight, try to get down to a healthy weight with diet and exercise.
  • If you’re a smoker, please quit. This is one of the most positive steps you can take to improve your overall health. Nicotine is a bladder irritant, and tobacco is a urinary tract carcinogen. Smoking may also cause you to cough, which in turn can trigger involuntary loss of urine.
  • If you have diabetes, work toward having your blood sugar levels under good control.

Medical:
  • Make a list of medications or supplements you are taking, and check to see whether any of them list overactive bladder or urinary incontinence as a side effect.
Most cases of overactive bladder and urge incontinence can be cured or controlled with treatment. Often the first step is to assess how well the bladder is functioning.

Your evaluation may include:
  • Bladder Diary: You may be asked to fill out a bladder diary and bring this to your appointment with your health care provider. (Link to bladder diary)
  • Urinalysis: At your first appointment to evaluate incontinence or overactive bladder, your urine may be checked to see if you have a urinary tract infection.
  • Post-Void Residual Urine Test: An in-office ultrasound of the bladder may be performed to see if you are emptying your bladder completely.
  • Cough Stress Test (CST): You may be asked to cough or bear down while being observed to see if you leak urine with a full bladder.
  • Physical Exam: A physical exam can sometimes help to determine the cause of your leaking urine and urinary problems.
  • Cystoscopy: In some cases, after numbing the urethra with a jelly, a camera may be placed into the bladder to visualize the inside of the bladder to assess for foreign objects, tumors, bladder stones or other abnormalities.
  • Urodynamic Testing: Sometimes more complex testing of the bladder is needed. Urodynamics is performed to test the function of the bladder. These tests are offered through urogynecologists: surgeons that specialize in women’s pelvic floor disorders and other conditions related to the female urinary and reproductive system.

Treatments for Overactive Bladder
  • Medication: Various oral medicines can help block the urge to urinate or enable the bladder to hold more urine.
  • Pelvic Floor Physical Therapy: Most women find that pelvic floor physical therapy helps improve symptoms.
  • Targeted exercises: While Kegel exercises are helpful for many women, others may need more targeted intervention. A pelvic floor physical therapist specializes in the muscles, nerves and ligaments of the pelvic floor region and can recommend the best exercises for you.
  • Bladder retraining: Women with OAB often go to the bathroom quite frequently, and over time, this can train the bladder to hold less urine. Bladder retraining involves using your pelvic floor muscles to prevent the loss of urine and using “mind over bladder” techniques to gradually increase time between bathroom visits.
  • Nerve Stimulation: Nerve stimulation can help retrain the many nerves involved in bladder function, leading to a long-term reduction in bladder wall muscle spasms.
  • Sacral nerve stimulation: An implanted device is used to stimulate the sacral nerve, just above the tailbone. This activates the nerves that control the bladder. An in-office procedure can be performed to see if this controls your OAB. If it is effective, the device can be implanted with a minor outpatient surgery.
  • Tibial nerve stimulation: Using a small needle (similar to that used in acupuncture) in the office, the tibial nerve is stimulated on the inside of the ankle to help activate the nerves that control the bladder.
  • Botox® Bladder Muscle Injections: Using a bladder camera in the office for guidance, Botox (botulinum toxin) is injected into the bladder to block the urge to urinate and enable the bladder to hold more urine.
What are the symptoms of overactive bladder?
OAB leads to sudden and intense urges to urinate; frequent trips to the bathroom; and, often, bladder leakage or inability to get to the toilet in time (urge incontinence). Any of the above can signal some amount of OAB, even if sudden urges to urinate aren’t the primary source of incontinence.

What’s the difference between overactive bladder and incontinence?
Incontinence refers to the involuntary loss of urine, for any reason—including coughing, laughing or sneezing (stress incontinence); an inability to get to the toilet in time due to a mental or physical barrier (functional incontinence); or a sudden and strong urge to urinate resulting in incontinence (urge incontinence). Overactive bladder is a combination of symptoms, including urge incontinence, the need to void frequently (urinary frequency), the sensation of needing to urinate now that is difficult to put off (urinary urgency) and waking up twice or more at night to urinate (nocturia).

I’m embarrassed. How can I bring this up with my health care provider at my appointment?
Overactive bladder is a common condition—you aren’t alone. Your provider wants to be aware of all your health concerns and connect you with the care you need. At your next appointment, try using words such as, “I’m concerned because there have been several times when I couldn’t control my bladder, and this hasn’t happened to me before. What do you recommend?”

If you don’t know who to talk to, call our Care Navigator and they will set you up with the right expert to help you evaluate treatment options and next steps.

How frequent is “frequent” when it comes to bathroom trips?
Most non-pregnant women urinate between four and seven times a day and once at night. Routinely using the bathroom eight or more times a day and more than once at night can signal bladder problems.

How common is overactive bladder?
Overactive bladder is quite common, affecting up to 15% of all women at any given time. All bladder control problems in general (including OAB, other forms of incontinence and difficulties with emptying the bladder) affect 30%-50% of women. Overactive bladder becomes more common with age, but it does affect younger women too.

Shouldn’t I expect some overactive bladder symptoms at my age?
While overactive bladder becomes more common with age, urinary incontinence is NOT “normal” at any age.

What causes overactive bladder?
Several conditions can cause the inability to hold urine long enough to reach the restroom, frequent urination during the day and night, and the strong urge to urinate. A urinary tract infection (UTI); lack of estrogen in the vagina and urethra (genitourinary syndrome of menopause); chronic constipation; bladder pain syndrome/interstitial cystitis; overactive pelvic floor muscles; multiple sclerosis or other neurological problems; bladder stones; and abnormal growths, including bladder cancer, diabetes and certain medications can all result in symptoms of overactive bladder. In some cases, overactive bladder can exist without any apparent cause.

What happens if overactive bladder is left undiagnosed and untreated?
It is important to evaluate the reason why you are having bladder control symptoms, because sometimes there are important health problems that are causing the symptoms, including infection, diabetes, neurological problems, or cancer. Sometimes the problem is an overfull bladder that is overflowing, and leaving this untreated for years can damage the bladder and kidneys. Leaving OAB or incontinence untreated can cause women to stop exercising and participating in physical and social activities, which can contribute to anxiety and depression. But the good news is that 80% to 90% of women who get treatment have substantial improvement in their symptoms. Treatment can have a significant impact on your quality of life and your ability to get out of the bathroom, be active and live your life the way you want.

What are the risk factors for overactive bladder?
While age is one risk factor for overactive bladder, the primary risk factors are caffeine and alcohol consumption; certain medications (diuretics); medical conditions like constipation, diabetes and multiple sclerosis; and too much fluid intake (less common).